Standing Committee E

[Mr. John Maxton in the Chair]

Health and Social Care

Clause 59 - Control of patient information

Liam Fox: I beg to move amendment No. 324, in page 52, line 44, leave out from beginning to end of line 50 and insert—
`information regarding any identifiable patient and relating to his physical or mental health or to his diagnosis or treatment'.

John Maxton: With this we may take the following: amendment No. 285, in page 52, line 46, leave out from `treatment' to end of line 50.
 Government amendments Nos. 338 to 340.

Liam Fox: This is a probing amendment on which we shall not divide the Committee. It seeks from the Minister clarification about the definition of patient information that will be useful to us when we debate later stages of the Bill.
 The definition of patient information provides the Secretary of State with the potential power to ban the use of important and beneficial non-personal data but also to share identifiable health data at his own discretion. The clause states that the Secretary of State will use his powers when they are in the public interest, but that could easily become the excuse for the suppression of politically inconvenient data. The explanatory note suggests as an example that regulations to prohibit the use of anonymised patient information being used for a purpose detrimental to the operation of the NHS could lead to cancer charities and others not being able to conduct surveys on postcode rationing. We believe that the clause is an attempt to squeeze out independent criticism of the NHS reminiscent of recent debates on the abolition of community health councils.The amendment would ensure a better definition than that in the Bill as drafted; we made a similar point earlier when we complained about the lack of clarity of some of the terms and therefore of their potential use.

Paul Burstow: I shall explain the thinking behind amendment No. 285, which would confine the scope of the order-making powers to information relating to individual patients. It would remove from the definition of patient information that is derived from information about an individual patient. The wording of the current definition is much too wide; it refers to information so derived however recorded, to any extent, directly or indirectly, and could be used to justify control of almost any information that relates to a patient. The amendment would remove the subsection's concluding words, which extend the order-making power to anonymised statistical information.
 We referred this morning to the judicial review of the Source Informatics case in 1999, much of which hinged on the use of anonymised information. The following is an extract from evidence in that case presented by the General Medical Council: 
 ``However, the GMC sees no legal or ethical principle which should prevent the transmission of wholly impersonal and anonymous data from which no individual patient can be identified. Patient interests in preserving their personal privacy cannot be harmed if the information, which derives from their medical records, is made impersonal and anonymous, so that no individual patient can be identified, but the aggregate can be used, e.g. for the effective running of a medical practice, for clinical or financial audit, or to estimate projected future need for particular medical intervention, equipment or drugs.'' 
The GMC also refers to the value that can be added through private databases, which is germane to our deliberations, stating that 
``it will seriously hinder the development of the useful data-bases (public and private) of research data and appropriate sharing of new knowledge and research. It may also mean that doctors registered in the United Kingdom are obliged to be more restrictive than doctors in other EU member states about the sharing of medical data, and this may hinder the free flow of medical services between such states, which I am advised and believe may be contrary to the requirements of European law. In this way, it may harm medical development and the provision of high-quality, efficient medical care.'' 
As the amendment and clause are drafted, a whole range of legitimate commercial uses of anonymised data will be excluded. I conclude with a final quotation about the review of private sector collection of data that the GMC put in that judicial review: 
 ``The presence or absence of profit cannot be the touchstone of what constitutes the public interest. Medical developments may occur in the public or private sector, and there should not be a public sector monopoly upon the obtaining or use of data derived from medical records. Nor does this view reflect the reality of the way in which anonymous and aggregated patient information is used at present. There is an important public interest in ensuring that there is equal access to information without unfair discrimination.'' 
The amendment tries to avoid the possibility of unfair discrimination. It is worth bearing in mind that when the Monopolies and Mergers Commission was asked to look at IMS's acquisition of that company, it said something that is quite relevant to the use of anonymised information: 
``development of the''— 
prescription data— 
``services and the improvements in market information they allow would, moreover, allow scope for greater efficiency in the marketing expenditure of pharmaceutical companies (in the UK and elsewhere) and overall net savings in their UK marketing costs. We believe that this in turn is likely to benefit the UK public in that, for example, the costs of medicines to the National Health Service (NHS) and to consumers would be reduced and the choice of medicines improved''. 
That was the conclusion of the MMC, not of the company but of the body that the Government have established to look at issues of competition. The case that the Government are making for the clause and, I suspect, against the amendment, is that allowing the private sector to be able to gather that information will enable it to target its marketing in such a way as to drive up drug costs unfairly and unreasonably. The MMC's evidence flatly contradicts that. Will the Minister explain why he does not agree with the MMC's conclusions? I hope that he will take on board both the concern and the detail of amendment No. 285.

George Young: I have added my name to amendment No. 285 and I wish to speak briefly in support of this group of amendments. From the debates this morning and this afternoon it is clear that we have been talking about two sorts of patient information. One is information about the individual patient; the other is aggregated or anonymised data about more than one patient.
 I have no difficulty with the Minister's arguments about protecting the confidentiality of the individual patient, although some of the powers may have gone slightly wider than was necessary. Where I have difficulty is with what the Minister is seeking to do with anonymised or aggregated data. The amendments seek to narrow the definition to focus on the first set rather than the second. Our concern is that the Government are using a clause on protecting the confidentiality of the patient to do something totally different. 
 The notes on clauses explaining why the Government need the powers on anonymised data are rather vague. There is one reference to the public interest. However, in our debate this morning, the Minister gave two reasons for having a broader definition rather than the narrow one in the amendments—one, to protect the financial interests of the NHS and the other to protect GPs from pressures. I am concerned about both those reasons. 
 The law on anonymised data is complex. One of the key legal cases is appropriately X v. Y or—more illuminatingly—X v. Y and others, which dates from 1988. The Minister needs to explain why he wants to use this clause for the much broader purpose. We have heard about the court case that was lost on appeal or on review. The Government seem now to be trying to change the law so that it will do what they tried to do before and we need to know why the Minister does not want the use of anonymised data. 
 Let us envisage a GP's practice that, for whatever reason, is either prescribing out-of-date medicine or, unlike other GPs, is not prescribing some new medicine. As I understand, anonymised data can enable the pharmaceutical industry to draw to the attention of the individual GP the fact that his prescribing practice is out of line. This information is called patient information but it is not really patient information at all. It is GP information. It is about the prescribing habits of the GPs and it is smuggled in under a clause dealing with patient information. I do not see anything wrong with the pharmaceutical industry using anonymised data to target particular GPs and bring to their attention information about their products. It could alert GPs about inappropriate prescribing. 
 However, I am unhappy about the notion that GPs need to be protected from pressure. The Minister wants to impose his judgment over that of the GPs as to what sort of advertising should reach them. It strikes me that that is excessively paternalistic and almost amounts to censorship with the Department imposing its judgment on the market in order to decide what information should reach the GPs. I am not sure that that is appropriate. 
 I was interested to see, Mr. Maxton, that the Treasury, in its review of Government information, has urged Government Departments to collaborate with private sector information intermediaries. In effect, that is exactly what this information under discussion is. The blunt question that I ask the Minister is whether he wants to use the powers in the clause to overturn the decision of the courts that went against him some time ago, and whether it is his intention to stop the collection of anonymised data and its use for the purposes that I have just outlined, using those powers. If that is what he wants to do, that would be an abuse of power because these powers should not be in this clause at all. I hope he will reassure the Committee that that is not his intention and that anonymised data that the pharmaceutical companies also pass on to patient organisations and medical research oganisations would be allowed to continue. I hope that he is not seeking to change a practice that has been going on for some time and that many people regard as inoffensive and even of potential benefit to patients and to the NHS.

John Denham: Amendments Nos. 285 and 324 limit the effect of the powers provided under either subsection (1) or (3) to information that identifies, and is likely to be confidential to, an individual. This has an impact, as is intended, on the power that is provided, and it is intended to provide, under subsection (1) that, it is anticipated, will be needed primarily to prevent information that does not identify individual patients from being used in ways that drive up NHS costs or are otherwise not in the interests of the patients. These amendments would prevent the Government taking action to prevent pharmaceutical companies and other commercial interests from exploiting patient information.
 The dividing lines on this issue between the Government and the Opposition are now fairly clear. The Opposition parties wish to line up behind the type of marketing strategy that the Government sought to prevent in the Source Informatics case and on which we lost the court case. That is clear.

George Young: Is the Minister aware that the Association of Medical Research Charities has expressed concern about clause 59 and has written to support some of the tabled amendments?

John Denham: There are two important issues here. It is disingenuous, if I may use that word, for the right hon. Gentleman to plead, in support of the central argument that he was making, concerns that have been expressed by a wider range of bodies and on which I have sought to reassure the Committee about the Government's intentions. The right hon. Gentleman was making it perfectly clear, and the hon. Member for Sutton and Cheam (Mr. Burstow) was equally clear, that he saw nothing wrong in the type of marketing that is aimed at persuading people, with very precise targeting, to change their prescribing practices in a way that will lead to a higher cost for the NHS. That may be just a point of disagreement across the Committee, but the issues raised by the medical research charities cannot be prayed in aid of that argument.
 I made quite clear in the earlier discussion, Mr. Maxton, and I do not want to go through all that again, why it has been necessary to frame the powers in the way that we have—albeit that, in response to some of the concerns expressed, we have amended them, quite rightly, to be limited to commercial matters. We need to have the breadth that the legislation will now have to be able to tackle those practices that we think are detrimental to the national health service.

Peter Brand: Would the Minister be able to point members of the Committee to a definition of ``commercial'' in this instance?

John Denham: The use of ``commercial purposes'' is well established, for example in the Town and Country Planning Act 1990. I do not believe that it is subject to a definition in that Act and it is clearly one that would need to be established in due course by the courts. It is not, however, a phrase or a piece of parliamentary drafting invented purely for this legislation. I understand, helpfully, that it is also incorporated in various Finance Acts.
 We have been asked whether the Government have sought to overturn the original judgment, which did not find in the Government's favour on the issue of whether the sale of data was an abuse of patient confidentiality. Lord Justice Simon Brown said that if the Government continued to view schemes such as that operated by Source Informatics as operating against the public interest, then we must take further powers in what he described fairly as 
``this already heavily regulated area to control or limit their effect.'' 
That is precisely what we are seeking to do through this legislation. 
 Government amendments Nos. 338 to 340 amend the definition of exactly what constitutes confidential information and make it clear that information may be confidential not only when an individual can be identified from the information in question, but also where that information might be combined with other information in the hands of—or likely to become available to—the person processing the information. This is an important clarification in current times, where people increasingly have a range of information that can be pieced together. They have the use of supportive information technology and can establish identity as if assembling a jigsaw. 
 Let me make it perfectly clear once more that it is not the intention behind this section of the clause to limit scrutiny or criticism of the NHS, nor does it introduce a blanket ban on the use of information for commercial or research purposes. It sets in place a procedure whereby the Secretary of State, after consultation and only after due parliamentary process, can take measures to stop the sort of practice that we regard as harmful to the NHS and that I was able to describe earlier.

Paul Burstow: That is the very point that I hope that the Minister can develop further. The explanatory notes say that one of the purposes of this power is to deal with matters that might be detrimental to the operation of the NHS. Could the Minister elaborate and give us some exemplifications of the sort of detriments to the NHS that would lead him to exercise this power?

John Denham: The explanatory notes—the hon. Gentleman understands the procedures—were drafted with the help of legal advice at the time at which the original clause was tabled. As I have made clear, we listened to the representations about the drafting of the original clause and we sought, I think rightly, to restrict the original scope. When we were going through that process, we considered the pros and cons of putting the word ``detriment'', which was in the explanatory note, on the face of the Bill. It was decided that there were so many ambiguities about the interpretation of ``detriment'' that it would not be right to do so. That is why we have chosen the simpler formulation of ``commercial purposes''.
 The hon. Gentleman will know that the explanatory notes do not constitute statute; they are there for guidance and assistance. However, he has provided me with the opportunity to explain why we have chosen the wording that we have to be on the face of the Bill.

Liam Fox: I beg to ask leave to withdraw the amendment.
 Amendment, by leave, withdrawn. 
 Amendments made: No. 338, in page 53, line 3, after `ascertainable' insert `(i)'. 
 No. 339, in line 4, after `information' insert 
`, or 
 (ii) from that information and other information which is in the possession of, or is likely to come into the possession of, the person processing that information'. 
No. 340, in line 5, leave out first `the' and insert `that'.—[Mr. Denham.]

John Denham: I beg to move amendment No. 341, in page 53, line 14, leave out `includes the purposes of' and insert
`means the purposes of any of the following'.

John Maxton: With this it will be convenient to take the following amendments: No. 329, in page 53, line 14, leave out `includes' and insert `means'.
 No. 330, in line 16, leave out from `treatment' to second `and' in line 17. 
 No. 236, in line 17, leave out `and social care'.

John Denham: Amendment No 341 is another amendment that we move following further discussion and consultation. It amends the current open definition of ''medical purposes'' to a closed definition listing a range of purposes. The list of purposes is broad enough to cover all the purposes that we envisage that it may need to cover and, as it is intended as a safeguard for patients, the logic that the definition should be closed rather than open ended seems to be inescapable.
 I acknowledge that amendment No. 329 essentially aims to achieve the same end and I hope that the hon. Member for Sutton and Cheam will be content with the slightly different wording suggested by parliamentary counsel. 
 Amendment No. 236 amends the definition of ``medical purposes'' provided in the clause to exclude social care services. While the definition is arguably still wide enough to encompass social care and indeed is interpreted in that way within the Data Protection Act 1998 where a similar definition exists, our intention was to put this beyond doubt and to send a clear signal of the importance that we put on the development of seamless care. 
 Amendment No. 330 has the effect of removing the purposes of managing health and social care purposes from the definition of medical purposes. We have based the definition here on the definition of medical purposes provided in the Data Protection Act 1998, and although we have added some clarification in line with Government policy relating to providing patients with seamless care and providing them with more information about their own care and treatment, they are purposes that are already covered by the Data Protection Act definition. It seems sensible that the core element of the definition should apply as widely as possible so that any reference to ``medical purposes'' can be generally understood without having to delve into different Acts. However, we should be clear that before regulations can be made to allow information to be used for management or for social care purposes they would have to pass the clear tests limiting the use of the powers set out in the Bill. 
 Agreement agreed to.

John Maxton: I have given careful consideration as to whether I should allow a clause stand part debate. However, I believe that the principles and related matters involved in the clause have been covered by the debate on the amendments and therefore I intend to put the question forthwith.
 Question put, That the clause, as amended, stand part of the Bill:—
The Committee divided: Ayes 11, Noes 7.

Question accordingly agreed to. 
 Clause 59, as amended, ordered to stand part of the Bill.

Clause 61 - Regulations and orders

John Denham: I beg to move amendment No. 342, in page 55, line 14, after `14(5)' insert
`or regulations under section (Supplementary and consequential provision etc.)(3)(c)'.

John Maxton: With this it will be convenient to take the following:
 Government amendments Nos. 343 to 346. 
 Government new clause 20--Supplementary and consequential provision etc.

John Denham: New clause 20 enables the Secretary of State to make by regulations such supplementary, incidental, consequential, transitory, transitional or saving provisions as necessary to give full effect to the Bill. That includes a power to amend or repeal any enactment, instrument or document. The Secretary of State may make such regulations only for the purposes of, in consequence of, or to give full effect to any provision of the Bill.
 The power is also available to the devolved Administrations in relation to devolved matters, and will come into force on Royal Assent. When the Secretary of State exercises the power, the negative procedure will apply. That is also the case in Scotland and Northern Ireland. The standard procedure adopted by the National Assembly for Wales will be used in Wales. 
 Amendments Nos. 343, 344, 345 and 346 simply make consequential provisions to include references to the new clause.

Philip Hammond: This is where the Bill really starts to get interesting. I know that the Minister was looking forward to this moment. I would like to probe a little on new clause 20. Although I understand that its provisions may not be terribly unusual—

John Denham: No, they are not.

Philip Hammond: The Minister says they are not, so why were they tabled in this way? Why were they not in the original Bill? Clause 63, which is not unusual either, already deals with minor and consequential amendments and repeals. Something has happened to make the Government decide that their drafting of the legislation is so sloppy that they need to add a catch-all clause at this late hour to allow them to deal with all the errors and omissions.
 The Minister may tell us that the new clause was needed because of the amendments that he has tabled to schedule 4. I do not want to foreshadow the interesting debate that we shall have on that schedule, but those amendments refer to at least four completely new statutes that are not mentioned in the schedule as it appears in the Bill. As the draftsmen went through the Bill a second and third time, they must have found that they had missed more and more consequential provisions. 
 The Minister now seems to be saying to the Committee that, on drafting the Bill, he and his colleagues put some of the statutes into the list of those affected by the Bill in schedule 4, but found that they had missed a few out and so have tabled amendments Nos. 352, 348, 351 and 354 to add new statutes to schedule 4. Now they have read the Bill again and cannot guarantee their level of competence, they want a catch-all power to amend any other legislation if they find that they have missed something else out. 
 I look forward to hearing what has happened since the publication of the Bill to lead the Government to conclude that the drafting is so deficient and sloppy—[Interruption.] I hope that the Minister will read that out—that he needs the catch-all new clause 20.

John Denham: On these occasions, Ministers are passed advice that is sometimes helpful, and sometimes not so helpful. When a Committee's deliberations on a Bill come to an end I always feel rather like the car driver—indeed I am that sort of car driver—who, while able to drive the car cannot explain in complete detail what happens under the bonnet. We are reliant to a degree on parliamentary counsel in such matters.
 The hon. Gentleman is right to point out that the clause is appropriate for such a complex Bill, with its cross-cutting measures, so that consequential issues that arise can be dealt with, although I do not agree with his comments about how the Bill has been drafted. He did not advance any substantive reason for not voting for new clause 20.

Desmond Swayne: I wonder whether the catch-all clause has anything to do with the fact that the Department has had a much shorter time than usual in which to table amendments. It has not been unforthcoming with amendments, but with a longer time it could have tabled many more.

John Denham: We seem to have plenty of time for speeches like that, so I do not see that pressure on the Committee has been overwhelming.

Philip Hammond: As we have some time, I should point out that the Minister's answer to my hon. Friend was a little too glib. My hon. Friend was drawing attention to the important point that if the programme for a Bill is too rushed, with the shortest possible gap between Second Reading and the commencement of Committee proceedings—in this case it was less than a week—and if there is also less than a week between the end of Committee proceedings and Report, the Government are bound to have insufficient time to deal with all the issues that have arisen and to consult outside bodies about the potential consequences of matters that have been raised. They will not have time to check and recheck their drafting and the detailed consequential amendments that are needed. My hon. Friend makes a good point in suggesting that that must be a factor in the need for the new clause.
 The Minister has not told us why the material in the new clause was not seen to be necessary at the outset. The tabling of the new clause tells me that something has happened during the past six or seven weeks, since the publication of the Bill, to give rise to the concern that the Government may need wider discretionary powers in the form presented in new clause 20. I hoped that the Minister will be able to tell us what that something was.

John Denham: Only in the most general terms. The Committee will be aware that, for reasons that we explained at the time, given that we are legislating for measures in the NHS plan, which was published only last July, we tabled a substantial number of amendments to the Bill's provisions on lists, for example. I believe that the clause is a consequence of, among other things, the measures that were presented after the publication of the Bill.
 Amendment agreed to. 
 Amendment made: No. 343, in page 55, line 29, at end insert— 
 `( ) Any regulations made by virtue of section (Supplementary and consequential provision etc.)(3)(c) shall be made by statutory rule for the purposes of the Statutory Rules (Northern Ireland) Order 1979 and shall be subject to negative resolution within the meaning of section 41(6) of the Interpretation Act (Northern Ireland) 1954.'.—[Mr. Denham.]
 Clause 61, as amended, ordered to stand part of the Bill.

Clause 62 - Interpretation

Question proposed, That the clause stand part of the Bill.

Philip Hammond: Can the Minister explain why there is no definition of primary care trusts in the clause? It defines NHS trusts, giving them the same meaning as under the National Health Service Act 1977. Primary care trusts are referred to in the Bill, but most of those references are to insert a definition of primary care trusts into the 1977 Act, which has been amended by the Health Act 1999. The reference to primary care trusts in clause 7(5) does not insert a section into another Act--it stands alone--but I can find no definition of primary care trusts in the Bill. Can the Minister explain that?

John Denham: I am happy to look into that and, if necessary, address it at the appropriate time. At this stage, we usually have what could be called a Hammond amendment, but we shall have to wait until Report to see whether the hon. Gentleman has found one.

Philip Hammond: It is kind of the Minister to offer to write to me, but he is inviting the Committee to vote on the proposition that clause 62 should stand part of the Bill. I take it that he is giving us an undertaking that, if the Bill does not contain an adequate definition of primary care trusts, he will table an appropriate amendment—with the appropriate credit—on Report.

John Denham: Certainly, should the drafting of the Bill prove to be deficient, we shall need to correct it—with the appropriate credit.
 Question put and agreed to. 
 Clause 62 ordered to stand part of the Bill.

Clause 63 - Minor and consequential amendmentsand repeals

John Denham: I beg to move amendment No. 347, in page 56, line 26, leave out from beginning to end of line 27.
 The amendment would delete subsection (3) because we now believe it to be redundant. It is entirely a technical measure. 
 Amendment agreed to. 
 Clause 63, as amended, ordered to stand part of the Bill.

Clause 64 - Powers of National Assembly for Wales Under Amended Acts

John Denham: I beg to move amendment No. 320, in page 56, line 34, at end insert—
 `(2A) The reference in that Schedule to the 1977 Act shall also be treated as referring to that Act as amended by sections 12(1) and 13(1) of the Government Resources and Accounts Act 2000 (but subject to the further amendments made by section 1 above).'.

John Maxton: With this it will be convenient to take Government amendments Nos. 321 and 322.

John Denham: Again, these are technical amendments. They ensure that the National Assembly for Wales (Transfer of Functions) Order 1999 operates in relation to section 97AA of the National Health Service Act 1977. That section was inserted into the 1977 Act by the Government Resources and Accounts Act 2000.
 Amendment agreed to. 
 Amendment made: No. 321, in page 56, line 35, leave out 
 `Subsection (1) does not affect' 
and insert 
 `Neither of subsections (1) and (2A) affects'.—[Mr. Denham.] 
 Clause 64, as amended, ordered to stand part of the Bill. 
 Clause 65 ordered to stand part of the Bill.

Clause 66 - Short Title, Commencement and Extent

Amendments made: No. 344, in page 57, line 3, after `61' insert 
`, (Supplementary and consequential provision etc.)'.
 No. 345, in page 57, line 28, leave out `to' and insert 
`, 61, (Supplementary and consequential provision etc.) and'.
 No. 346, in page 57, line 32, after `60' insert 
`and section (Supplementary and consequential provision etc.)'.—[Mr. Denham.]
 Question proposed, That the clause, as amended, stand part of the Bill.

Desmond Swayne: Would the Minister say when he anticipates the Bill coming into force, given that the clause gives the Secretary of State the power to make orders to bring various parts of the Bill into effect at different times? What priorities does the Minister have for the various parts of the Bill, and when does he anticipate bringing them into effect?

John Denham: I need to deal with each section in turn; perhaps I can write to the hon. Gentleman. However, I can tell him about two or three specific parts of the Bill. I have made it clear that we are aware of the timetable set by the October 2001 publication date of the GMC's advice on patient information to members of the profession. We need to make progress in enacting those parts of the Bill. We want to have free nursing care provisions in place by October. We are anxious to move ahead as quickly as possible on the formation of the GP lists, although I cannot give a date. We are seeking, with the BMA, to give locum doctors membership of the NHS pension scheme, backdated to 1 April, and we do not want too long a gap between those provisions coming into force and the formation of the lists. We are moving as quickly as we can, but there will be slight variations between different parts of the Bill.

Desmond Swayne: When will the patients forums be put in place, and when the will the consequential abolition of the CHCs occur?

John Denham: The NHS plan states that we intend to abolish CHCs in April 2002, so we will need to have the replacement provisions in place as of that date. The necessary legislation will be required in advance of that.
 Question put and agreed to. 
 Clause 66, as amended, ordered to stand part of the Bill.

Schedule 4 - Minor consequential amendments

John Denham: I beg to move amendment No. 352, in page 64, line 4, at end insert—
`Health Services and Public Health Act 1968 (c. 46)
 .—(1) The Health Services and Public Health Act 1968 shall be amended as follows.
 (2) In section 59 (extension of power of user by Crown of patented invention to user for certain health services)—
(a) in subsection (1), after ``pharmaceutical services,'' insert ``local pharmaceutical services,''; and
(b) after section 59(2A) insert—
``(2B) In subsection (1) the reference to local pharmaceutical services is a reference to local pharmaceutical services provided under—
(a) a pilot scheme established under section 29 of the Health and Social Care Act 2001;
(b) an LPS scheme established under Schedule 8A to the National Health Service Act 1977; or
(c) any corresponding provision of the law in force in the Isle of Man.''.
 (3) In section 63 (provision of instruction for certain persons employed in health or welfare activities), after subsection (2)(ba) insert—
``(bb) the provision of a local pharmaceutical service under a pilot scheme established under section 29 of the Health and Social Care Act 2001 or under an LPS scheme established under Schedule 8A to the 1977 Act or under any corresponding provision of the law in force in the Isle of Man and an activity involved in or connected with the provision of such a service;''.'

John Maxton: With this it will be convenient to take Government amendments Nos. 348 to 351, 353, 355 and 354.

John Denham: These amendments are consequential, and relate to the introduction of local pharmaceutical services. I am happy to deal with them at greater length if the Committee would like me to do so, but if not, I shall be as brief as possible. They insert into the schedule a variety of provisions that ensure that LPS is appropriately dealt with in legislation.
 Amendment agreed to. 
 Amendments made: No. 348, in page 64, line 11, at end insert— 
`Patents Act 1977 (c. 37) 
 . In section 56 of the Patents Act 1977 (interpretation, etc. of provisions about Crown use), after subsection (4)(a)(ii) insert ``, or— 
 (iii) local pharmaceutical services provided under a pilot scheme established under section 29 of the Health and Social Care Act 2001 or an LPS scheme established under Schedule 8A to the National Health Service Act 1977, or under any corresponding provision of the law in force in the Isle of Man''.'
 No. 205, in page 64, line 25, at end insert— 
 `(6A) In section 99 (regulation of financial arrangements), in subsection (1) after paragraph (ba) insert— 
 ``(bb) Patients' Forums,''.'.
 No. 349, in page 64, line 31, at end insert— 
 `( ) In section 103 (special arrangements as to payment of remuneration)— 
 (a) in subsection (3), after ``pharmaceutical services'' insert ``or such local pharmaceutical services'';
(b) in subsection (3)(a), after ``of this Act'' insert ``or by virtue of Schedule 8A to this Act''; and
(c) after subsection (3) insert— 
 ``(4) In subsection (3), ``local pharmaceutical services'' has the meaning given by paragraph 1(3) of Schedule 8A to this Act. 
 (5) In subsection (3)— 
 (a) the reference to local pharmaceutical services includes a reference to local pharmaceutical services provided under pilot schemes established under section 29 of the Health and Social Care Act 2001 and, in that case, ``local pharmaceutical services'' has the meaning given by that section; and 
 (b) in respect of local pharmaceutical services provided under such schemes, the reference to Schedule 8A is a reference to that section.''.'
 No. 350, in page 64, line 35, at end insert— 
 `( ) In Schedule 12A (expenditure of Health Authorities and Primary Care Trusts)— 
 (a) in paragraph 7(1), after the definition of ``pharmaceutical services'' insert ``;
``local pharmaceutical services'' has the meaning given by paragraph 1(3) of Schedule 8A to this Act; 
 ``remuneration referable to the cost of drugs'' includes (except in paragraph 1(2)(b) and subject to sub-paragraph (2)) remuneration payable to persons providing local pharmaceutical services'';
(b) in paragraph 7(2), after ``pharmaceutical services'' insert ``or local pharmaceutical services'';
(c) after paragraph 7(3) insert— 
 ``(4) In this paragraph references to local pharmaceutical services include references to local pharmaceutical services provided under pilot schemes established under section 29 of the Health and Social Care Act 2001, in which case that expression has the meaning given by that section.'''
 No. 351, in page 64, line 35, at end insert— 
`Copyright, Designs and Patents Act 1988 (c. 48) 
 . In section 240 of the Copyright, Designs and Patents Act 1988 (Crown use of designs), after subsection (4)(b) insert ``or 
 (c) local pharmaceutical services provided under— 
 (i) a pilot scheme established under section 29 of the Health and Social Care Act 2001; or 
 (ii) an LPS scheme established under Schedule 8A to the National Health Service Act 1977.''.
Trade Union and Labour Relations (Consolidation) Act 1992 (c. 46) 
 . In section 279 of the Trade Union and Labour Relations (Consolidation) Act 1992 (health service practitioners), after paragraph (b) insert ``or as a person providing local pharmaceutical services under a pilot scheme established by a Health Authority under section 29 of the Health and Social Care Act 2001 or under an LPS scheme established by a Health Authority under Schedule 8A to the National Health Service Act 1977;''.'
 No. 353, in page 65, line 1, after `schemes)' insert— 
`—(a) in subsection (2), after ``dental services'' insert ``, and may not combine arrangements for the provision of personal medical services or personal dental services with arrangements for the provision of local pharmaceutical services under LPS schemes (within the meaning of paragraph 1(3) of Schedule 8A to the National Health Service Act 1977) or under pilot schemes made under section 29 of the Health and Social Care Act 2001''; and
(b)''
 No. 355, in page 65, line 7, at end insert— 
 `( ) In section 21 (provision of personal medical or dental services), in subsection (2)(a) of the section 28C to be inserted into the 1977 Act, after ``dental services'' insert ``, and may not combine arrangements for the provision of personal medical services or personal dental services with arrangements for the provision of local pharmaceutical services under LPS schemes (within the meaning of paragraph 1(3) of Schedule 8A to this Act) or under pilot schemes made under section 29 of the Health and Social Care Act 2001''.'
 No. 114, in page 65, line 8, leave out sub-paragraph (4). 
 No. 354, in page 65, line 23, at end insert— 
`Freedom of Information Act 2000 (c. 36) 
 . In Schedule 1 to the Freedom of Information Act 2000 (public authorities for the purposes of the Act), after paragraph 45 insert— 
 ``45A. Any person providing local pharmaceutical services under— 
 (a) a pilot scheme established under section 29 of the Health and Social Care Act 2001; or 
 (b) an LPS scheme established under Schedule 8A to the National Health Service Act 1977, 
 in respect of information relating to the provision of those services.''.'—[Mr. Denham.]
 Schedule 4, as amended, agreed to.

Schedule 5 - Repeals

Amendments made: No. 115, in page 66, column 3, line 38, leave out from beginning to end of line 40. 
 No. 322, in page 66, line 47, at end insert— 
 `2000 c. 20.Government Resources and Accounts Act 2000.Section 12(2).Section 13(2).'.
 Mr. Denham.

Schedule 5, as amended, agreed toNew Clause 9Joint overview and scrutiny committees etc

New Clause 9 - Joint overview and scrutiny committees etc

`.—(1) In this section, relevant functions in relation to a local authority are functions which are, or, but for regulations under this section, would be, exercisable under section 21(2)(f) of the Local Government Act 2000 (``the 2000 Act'') by an overview and scrutiny committee of that authority. 
 (2) Regulations may make provision under which— 
 (a) two or more local authorities may appoint a joint committee of those authorities (a ``joint overview and scrutiny committee'') and arrange for relevant functions in relation to any (or all) of those authorities to be exercisable by the committee; 
 (b) a local authority may arrange for relevant functions in relation to that authority to be exercisable by an overview and scrutiny committee of another local authority; 
 (c) a county council for any area may arrange for one or more of the members of an overview and scrutiny committee of the council for a district comprised in that area to be appointed as— 
 (i) a member of an overview and scrutiny committee of the county council or another local authority, for the purposes of relevant functions of the committee in relation to the county council, or 
 (ii) a member of an overview and scrutiny committee of the county council, for the purposes of relevant functions of the committee in relation to another local authority. 
 (3) The regulations may in particular— 
 (a) provide for arrangements to be made only in specified circumstances, or subject to specified conditions or limitations; 
 (b) in relation to joint overview and scrutiny committees, make provision applying, or corresponding to, any provision of section 21(4) and (6) to (15) of the 2000 Act, with or without modifications. 
 (4) The regulations may require, or enable the Secretary of State to direct, a local authority— 
 (a) to make arrangements of any description within subsection (2), and 
 (b) to comply with such requirements in connection with the arrangements as may be specified in the regulations or as the Secretary of State may direct. 
 (5) In section 7(3) and (5), references to an overview and scrutiny committee include references to a joint overview and scrutiny committee. 
 (6) In subsection (2)(c), references to an overview and scrutiny committee of a county council include references to a joint overview and scrutiny committee of the council and another local authority. 
 (7) Section 21(10) of the 2000 Act does not apply to persons who are members of an overview and scrutiny committee by virtue of arrangements under regulations under subsection (2)(c). 
 (8) In this section ``local authority'' means a county council, county borough council, district council or London borough council.'.—[Mr. Denham.] 
Brought up, read the First and Second time, and added to the Bill.

New Clause 10 - Transfer of staff in connection with partnership arrangements

`.—(1) The Health Act 1999 shall be amended as follows. 
 (2) At the end of section 31 (arrangements between NHS bodies and local authorities) there shall be added— 
 ``(9) Schedule 2A makes provision with respect to the transfer of staff in connection with arrangements made by virtue of this section.'' 
 (3) In section 62 (regulations and orders), at the end of subsection (1) there shall be inserted ``, unless it is an order under paragraph 2 of Schedule 2A.'' 
 (4) The Schedule set out in Schedule (Partnership arrangements: transfer of staff) to this Act shall be inserted in the Health Act 1999 as Schedule 2A to that Act.'.—[Mr. Hutton.] 
Brought up, and read the First time.

John Hutton: I beg to move, That the clause be read a Second time.

John Maxton: With this we will take Government new schedule 1— Partnership Arrangements: transfer of staff.

John Hutton: The new clause and new schedule are important. I will explain to the Committee why we are introducing them. They deal with protecting the employment rights of staff who may be transferred under the provisions of the Bill. Care trusts need stability for their staff. There will be integrated partnerships of staff from local authorities and the national health service. We want them, where appropriate, to be able to transfer in the knowledge that their terms and conditions will be secure, and the new schedule is designed to ensure that that happens. It will enable the Secretary of State or the National Assembly for Wales to make an order transferring staff to ensure that the terms and conditions of employment are properly protected.
 The proposals would enable orders to be made replicating the provisions of the Transfer of Undertakings (Protection of Employment) Regulations 1981 and make provision for pension rights. I want to reassure the Committee that this is not legislation for legislation's sake. Apparently, there is some doubt about the extent to which TUPE regulations apply when there is a transfer within the public sector from one agency to another. That uncertainty has arisen from a recent decision of the European Court of Justice about the Henke case that arose in Germany. We need to remove such doubt, which is precisely what the new clause and new schedule will do. They will allow for regulations to be made requiring consultation about the proposals and the options for the staff. They will preserve the terms and conditions of employment for staff and ensure continuity of service under the transfer. 
 We have also made provision to deal with cases in which the employee works partly for the transferor and partly for the transferee, so much of the contract that is transferred to the transferee will also be similarly protected. Under the TUPE regulations, pension rights are not currently protected. An order under the new schedule 2A will mean that pension rights can be fully protected in such circumstances. The provision allows flexibility as different people may wish to do different things about their pension when they transfer employment. We want the staff employed by care trusts to deliver the highest possible quality care. That will be made much easier if staff feel properly valued and their own employment rights are properly protected. I am sure that all of us would want that for ourselves, and it is what we want to deliver to staff who will be affected by the new arrangements. 
 I reassure members of the Committee that the new clause and new schedule are fully compatible with the Cabinet Office's statement of practice on staff transfers in the public sector. Paragraph 5 of the statement says that, in circumstances in which TUPE does not apply in strict legal terms to certain types of transfer between parts of the public sector, the principles of TUPE should none the less be followed, where possible using legislation to affect the transfer. It also states that the staff involved should be treated no less favourably than they would have been had the regulations applied. There should be appropriate arrangements to protect occupational pensions, redundancy and severance terms for staff in all those types of transfer. That is what the new schedule requires.

Desmond Swayne: I want to ask one or two questions that have probably arisen from a poor understanding of the technical language of the provisions rather than from issues of substance. I would welcome some reassurance from the Minister. Paragraph 2(2) of new schedule 1 states:
 ``An order may be made under this paragraph only if any prescribed requirements about consultation have been complied with in relation to each of the employees to be transferred.'' 
 Will the Minister explain what is meant by ``prescribed requirements''? 
 I became confused—[HON. MEMBERS: ``Oh.''] At least I have read the new schedule, which I suspect is more than can be said for some members of the Committee, whose attention to such matters could be described as transitory—perhaps ``sporadic'' might be a better word to use. Paragraph 3(1)(b) of the proposed new schedule refers to the contract of employment having 
``effect from the date of the transfer as if originally made between the employee and the transferee.'' 
Paragraph 3(2)(b) refers to 
``anything done before the date of the transfer by or in relation to the transferor in respect of the employee or his contract of employment shall be deemed from that date to have been done by or in relation to the transferee.'' 
I may have been confused by the legal language used, but I began to wonder whether those two provisions contradicted each other. 
 I should appreciate the Minister's reassurance about the position of redundancies. One's right to a redundancy payment is determined to an extent by one's original employment date. One accrues rights according to one's length of service. I had begun to suspect that the beginning of the contract date would be the date of the transfer—that was my impression from the language used—rather than the original date that the employee began with the transferor. Will the Minister give me an assurance on that matter? 
 Paragraph 3(5) of new schedule 1 refers to the rights of an employee for whom 
``a substantial change is made to his detriment in his working conditions''. 
Will the Minister say what a substantial change might be for the purposes of that provision?

John Hutton: I can put the hon. Gentleman's mind at rest on those issues. We are trying to put staff who have their employment transferred under such arrangements in the same position as if the TUPE regulations applied. The TUPE regulations have been on the statute book for more than 20 years. A substantial body of case law and precedent have been established that demonstrate and clarify some of the practical concerns and issues that he raised. With the greatest respect to the hon. Gentleman, I shall not detain the Committee by listing those precedents to establish the parameters of the TUPE regulations.
 I shall try to deal with the three points that the hon. Gentleman made. The purpose of paragraph 2(2) is to make it clear that there will be proper consultation with the work force and trade unions affected by the changes before the Secretary of State issues an order under the new schedule and new clause. That is designed to ensure best practice in employment relationships between the employers concerned. The hon. Gentleman asked me to say exactly what the requirements will be, but we have not yet prescribed them. I can only describe them generally by referring to the consultation that he would expect to apply. 
 The other two points made by the hon. Gentleman related to what I accept are difficult issues—ensuring continuity of the employment contracts when there is a transfer between employers, and continuity of the obligations and responsibilities of the employer. It is not only contracts that must be transferred smoothly in such circumstances, but continuous liabilities of employers. He asks me to explain through practical examples the set of circumstances that have given rise to his concern. Again, with the greatest respect to the hon. Gentleman, it would not be helpful for me to do that, partly because if I did so we would be here until next Friday lunchtime.

Philip Hammond: Could the Minister touch on an issue that he and I discussed in relation to another Bill in Committee? Is he satisfied in his own mind that paragraph 5, which deals with divided employments, is fair and reasonable? Is it fair and reasonable to impose on an employee the obligation to split his employment into two part-time employments: one continuing with his former employer and one with a new employer? Is the Minister entirely comfortable with that?

John Hutton: We cannot force employees to do anything under such provisions, which I am sure that the hon. Gentleman understands. If an employee does not want to work under those arrangements once the transfer has taken effect, he or she is perfectly able to express that preference. The TUPE regulations provide a framework within which there can be continuity of employment rights and continuity of the responsibilities of the employer. It is important that there is no confusion about that.
 The hon. Member for New Forest, West (Mr. Swayne) had another query about paragraph 3(5) and the meaning of ``substantial change''. All I can say is that a body of case law has developed during the past 18 or 19 years since the TUPE regulations were enacted. Attention has therefore been directed to precisely the points that he raised. Clearly, I do not have chapter and verse of that case law to which to refer this afternoon, but the principles have been fully explored in employment tribunals and higher courts. A clear body of case law will set out the circumstances in which the provision can be triggered, and how any issues can be resolved.

Philip Hammond: The schedule is intended to deal with the creation of care trusts. In the substantive debate on the subject, the Minister of State, the right hon. Member for Southampton, Itchen (Mr. Denham), said that it would be possible to unwind a care trust and revert to the previous arrangements. Will the Minister of State, the hon. Member for Barrow and Furness (Mr. Hutton), tell us whether there will be a return ticket for employees if a designation as a care trust is terminated? Will staff return to their employer with no loss of seniority or any other accrued privileges they would have had if that designation had never been given?

John Hutton: I can give the hon. Gentleman that assurance. The new provisions are to cover the transfer from one public-sector agency to another. The traffic is not all one way. If, as an example, the parties applied to the Secretary of State and he made an order to dissolve a care trust under clause 45, the provisions would apply in the same circumstances as those that we are discussing.
 I am grateful to the hon. Gentlemen for attempting to clarify some of the issues. I hope that I have reassured them that we are not reinventing the wheel but building on a substantial body of case law and precedent. The provisions are designed largely around existing regulations that have stood the test of time. 
 Question put and agreed to. 
 Clause read a Second time, and added to the Bill.

New Clause 12 - Premises from which piloted servicesmay be provided

`. The relevant authority may by regulations— 
 (a) prevent (except in such circumstances and to such extent as may be prescribed) the provision of both piloted services and pharmaceutical services from the same premises; 
 (b) make provision with respect to the inclusion, removal, re-inclusion or modification of an entry in respect of premises in a list under section 42 of the 1977 Act.'.—[Mr. Jamieson.] 
Brought up, read the First and Second time, and added to the Bill.

New Clause 20 - supplementary and consequential provision etc.

`.—(1) The Secretary of State may by regulations make— 
 (a) such supplementary, incidental or consequential provision, or 
 (b) such transitory, transitional or saving provision, as he considers necessary or expedient for the purposes of, in consequence of or for giving full effect to any provision of this Act. 
 (2) The provision which may be made under subsection (1) includes provision amending or repealing any enactment, instrument or document. 
 (3) The power to make regulations under this section is also exercisable— 
 (a) by the National Assembly for Wales, in relation to provision dealing with matters with respect to which functions are exercisable by the Assembly; 
 (b) by the Scottish Ministers, in relation to provision that would be within the legislative competence of the Scottish Parliament; 
 (c) by the First Minister and deputy First Minister acting jointly, in relation to provision dealing with transferred matters (within the meaning of section 4(1) of the Northern Ireland Act 1998). 
 (4) Nothing in this Act shall be read as affecting the generality of subsection (1).'.—[Mr. Jamieson.] 
Brought up, read the First and Second time, and added to the Bill.

New Clause 15 - General practitioners' lists

`.—(1) The Secretary of State shall make regulations relating to the content of contracts for the provision of general medical services in the area. 
 (2) Regulations under this section— 
 (a) shall require that specified contracts with general medical practitioners must provide that— 
 (i) a general medical practitioner may not refuse to accept a patient onto his list or remove a patient from his list unless such criteria as are specified inthe regulations are satisfied; and 
 (ii) where a general medical practitioner decides to refuse to accept a patientonto his list or to remove a patient from his list written reasons must beprovided to the patient; and 
 (b) may include any other provision the Secretary of State considers appropriate.'.—[Dr. Brand.] 
Brought up, and read the First time.

Peter Brand: I beg to move, That the clause be read a Second time.
 The Bill is wide-ranging, and we were disappointed that the Government did not include provisions on patients' rights to information, which many of us felt were necessary. I am grateful to my hon. Friend the Member for Sutton and Cheam, who has done a lot of work with the citizens advice bureau in drafting the new clause. 
 I have never struck a patient off my list, but I have occasionally been relieved when patients have gone. The relationship between doctors and patients works better when they get on with each other, or at least are not at open war. It is important for practitioners to analyse why they take people off their list or why they refuse to accept them. It is also important for the reasons why a relationship has broken down to be explained to a patient. 
 It would be helpful to the contractor and the patient if the Minister considered the substance behind new clause 15. Many people in patient and consumer organisations and in the NHS have felt that the problem is long overdue for attention.

Desmond Swayne: We are generally supportive of the provisions in the new clause. Constituents have come to see me at my advice sessions to complain that they have been removed from their GP's list. I must say that I had some understanding of the GP who removed them. I have often felt that if there were a power for a Member of Parliament to remove a constituent from his list, it might well be worthwhile pursuing such a power.

Peter Brand: There is always the option to invite them to vote for another candidate, which is something I quite frequently do.

Desmond Swayne: The hon. Gentleman is very kind. However, it is quite proper to remove patients from a GP's list and there are provisions for their immediate removal in cases of violence. That is quite right. Nevertheless, there is a clear case to be made for written reasons to be made available to the patient. That would prevent many abuses. The medical professional bodies regard it as best practice to provide the reason. Therefore, I see no reason, for not requiring it to be provided. Perhaps we could turn the matter on its head and ask the Minister to come up with plausible reasons for saying why and in what circumstances it would not be proper to provide a written reason for removing someone from the list?

John Denham: We have an opportunity for a brief debate on a topic that we should not be trying to resolve through this Bill, although it is certainly a live one that has concerned this House and the Health Select Committee and I shall refer to the work that is under way. GPs have always had the right to remove patients from their lists without giving a reason—just as patients have had the right to withdraw from a doctor's list without giving reasons. Historically, the view has been that the need for either party to give a reason could be an inhibiting influence on what might be the appropriate course of action. We would expect GPs to exercise their option to de-register patients only where there has been an irretrievable breakdown of the doctor-patient relationship or where the patient has been violent, or has threatened violence towards the GP or the GP's staff. The General Medical Council has advised doctors that they should not end their professional relationship with a patient unless they are satisfied that the decision is fair and does not contravene general guidance that it is unacceptable to discriminate on grounds of lifestyle, culture, belief, race, colour, gender, sexuality, age, social status or perceived economic worth.
 The Government are concerned that patients who are removed from GP lists without their consent are treated with consideration and openness. Being removed from a doctor's list can be a distressing experience and patients look for reassurance and explanation. It is worth noting that the profession's representatives advise doctors to give reasons for removal wherever possible. 
 The current position is that, following the recommendation of the Select Committee on Public Administration after the 1997-98 report of the Health Service Ombudsman, we have agreed to a survey into the scale of and the reasons behind patient removal by GPs. The survey was commissioned from the Medical Care Research Unit at Sheffield university and its report is expected before Easter. 
 Although I have not seen the results, I am advised that preliminary results give a national picture of de-registrations for reasons other than patients leaving the area, and seem to suggest that the main reason for removing patients is violence or threatening behaviour. However, it may be too early to be certain on the conclusions of that report. 
 We have commissioned the research and I would not like to pre-judge today what the Government's response might be when we have received this research and considered it properly. Certainly paragraph 10.5 of the NHS plan states that 
``patient choice will be strengthened. Patients have the right to choose a GP.'' 
 We want 
``to make it easier for patients to exercise informed choice, [so] a much wider range of information will be published about each GP practice''. 
Discussions are under way between the Department and the BMA to ensure that the GP practice leaflet includes additional information to enable patients to make informed choices. We want to see the results of the survey and then consider what further action may be needed to improve the handling of the difficult issue of separation of doctor and patient.

Peter Brand: I am grateful for that reply. I hope that the Minister does not rely only on a survey and figures. It would be quite wrong if even a small number of patients were taken off GP's lists without reasonable cause: for example, so that their GPs could meet Government targets on immunisation. Families or extended families are sometimes thrown off a list because the GP does not get on with one family member. I hope that the Minister will also recognise that a code of good practice is an excellent mechanism for good practitioners, but it does not necessarily meet the requirements.
 I beg to ask leave to withdraw the motion. 
 Motion and clause, by leave, withdrawn.

New Clause 16 - Reviews of care trusts

`.—(1) The relevant authority shall, not less than two years and not more than three years after the date of designation of any trust as a Care Trust—
(a) arrange for a review of the operation and effectiveness of that trust; and
(b) arrange that the review includes consultation with all parties and bodies that the relevant authority considers have an interest in or are affected by the operation of that trust; and
(c) arrange that the review includes an evaluation of the benefits to recipients of health and social care services within the area of the trust.
 (2) The relevant authority shall publish a report detailing the findings of any review conducted in accordance with subsection (1) above in such manner as it shall consider appropriate.'.—[Mr. Hammond.]
 Brought up, and read the First time.

Philip Hammond: I beg to move, That the clause be read a Second time. The new clause attempts to write on to the face of the Bill provision for proper review of the operation and effectiveness of care trusts when they are established and the publication of the results of those reviews. It would apply to care trusts established under clause 45 or clause 46 by which the Secretary of State takes powers to set them up by order.
 We are prepared to be open-minded about care trusts. We have listened to the arguments for them and we understand the logic of what is being proposed. However, it is a complex matter and, as Ministers have acknowledged, care trusts depend for their success upon people being able to work together to deliver services. On Tuesday, the hon. Member for Isle of Wight (Dr. Brand) referred to the need to merge two different cultures—the local government social services approach and the health service ethos, which is somewhat different. Everyone would acknowledge that there is a fairly tough challenge ahead to make care trusts work. 
 We know that in some areas social services and health bodies work together extremely well and very closely, and in other areas, frankly, they do not. Given that experience, we all acknowledge that it is possible that the outcomes for care trusts will be different in different cases. There will be lessons to be learned and best practice to be picked up and spread around. 
 The Government are keen on talking about evidence-based medicine and health care, and that is the right way to proceed. However—the Minister will forgive me if I use the same example again—we are not encouraged by of what happened in respect of NHS Direct. It was a perfectly plausible idea—one that the previous Government piloted in Wiltshire—that may have much to contribute to the future delivery of health care services. We should also work always on the basis that as a scheme is rolled out and pilots are established, they are fully evaluated and costed and properly reviewed and that decisions are taken in the light not of the need for a press announcement or a headline grabber the next morning, but of the evidence available, subject to proper objective evaluation. 
 In new clause 16 we are telling the Minister that we believe that it is a practical necessity that the operation of care trusts is properly reviewed and that the results of those reviews are published, and that that is essential to building public and professional confidence in the bodies concerned. 
 I have no doubt whatever that it is the Government's intention to review what happens to the first wave of care trusts. It would be bizarre to imagine that the Government would not be very interested indeed in keeping a close eye on what is happening. However, we do not want to find that the model is being encouraged, or perhaps even a little more than encouraged—people may be under pressure to adopt it—on the ground of supposed benefits that the Government claim to have detected on the basis of some internal review the results of which are not available for scrutiny, and therefore for objective analysis. 
 I hope that the Minister will accept the new clause as an attempt to ensure that the roll-out of care trusts is based on proper evidence and that best practice is disseminated. If he cannot accept it, I hope that he will be able to give the Committee some clear assurances about the independence of the evaluations that will take place, and an assurance that those evaluations will be published so that other bodies that may be considering making the leap into care trusts will be able to learn from the experience of those who have already gone down that route and make a properly informed decision.

John Hutton: The hon. Gentleman is right to say that the Government have a strong interest in ensuring the effectiveness of the new care trusts. He put it very well. We discussed the relevant proposals at length on Tuesday. Of course there is some cynicism, doubt and uncertainty about the value that care trusts will bring. We remain strongly of the view that they will provide an important new opportunity for closer partnership working.
 We had a long debate about the merits and principles underlying the proposals. We believe that closer partnership and working between those two very important pillars of our welfare society will enhance the patient and service user experience. 
 In making his argument, the hon. Gentleman probably dropped into it the seed of its own destruction. The hon. Gentleman's assumption in the new clause is first, that the existing review arrangements are not robust enough, or secondly, that they are somehow not publicly available, or thirdly, that the Government, for reasons that he would probably describe as ideological, would force the new system down the throats of a reluctant health and social care community against the evidence of whether they were working effectively. 
 We do not want to revisit the old debates about how his party ran the national health service, but that is not how we intend to run it. I will deal with his argument on three levels. Are there sufficient review arrangements and are the robust enough? Yes is the answer to that question.

Philip Hammond: That is very good.

John Hutton: Yes, it is a persuasive argument. The hon. Gentleman does not have to take my word for it. He needs to look at the breadth and depth of the review arrangements that are in place. I say to him again that they are much more robust and substantial than has previously been the case in respect of our ability to monitor the performance of public services.

Philip Hammond: I am grateful to the Minister and I would love simply to be able to accept his yes. However, the Minister is a fairly rigorous person. Is he really satisfied with the review process that has been applied to NHS Direct? Does he believe that NHS Direct has been rigorously and independently assessed and that its cost effectiveness has been properly evaluated prior to the announcement of the nationwide roll-out?

John Hutton: Yes, I do. The benefits of NHS Direct are becoming clear to patients. In my constituency recently a man and his young family contacted NHS Direct. The young boy was developing meningitis, and if it had not been for that call to NHS Direct there is some doubt as to whether he would have survived.
 I am using that as an example of the value of the benefits of NHS Direct, not to confirm the hon. Gentleman's point about the robustness of the review arrangements, but simply to highlight the benefits that NHS Direct undoubtedly has. NHS Direct has saved lives. I should be interested to know how the hon. Gentleman's benefit-cost analysis would put a value on the price of those lives. Perhaps he will tell us what he thinks that might be.

Peter Brand: If I could bring the discussion back to the review of care trusts, will the Minister tell me whether the same arrangements that are so robust in his view will apply to voluntary care trusts as well as imposed care trusts? Last week I asked whether the dissolution of a care trust, which is allowable under Government amendment No. 418, applies only to voluntary care trusts, or whether, after sensible assessment through the robust procedures of which the Minister spoke, is also available to the imposed care trust.

John Hutton: Yes. The same review arrangements will apply. I shall list them briefly. Local authorities have a statutory duty to provide best value. NHS trusts are under a statutory duty of quality. The Commission for Health Improvement and the social services inspectorate each have a role. The local authorities have a scrutiny role, and the work of performance management is conducted by the regional office. We now have published data on performance assessment in local authorities and the NHS.
 Performance tests and the assessment framework, best value reports, the role of the Commission for Health Improvement and of the social services inspectorate are all in the public domain. I assure the hon. Gentleman that there is no question of the Department of Health somehow cobbling together review arrangements and keeping them secret, thus making local government and the NHS follow the course of conduct that we want them to pursue. We want to put in place properly conducted, robust, independent review arrangements to demonstrate our case for closer partnership working. We have everything to gain from that approach. 
 The hon. Gentleman may be aware that the Department has a research and evaluation programme that will allow it to take a strategic view of the impact of care trusts. For example, we have commissioned the national primary care research and development centre in Manchester, in conjunction with the King's Fund, to undertake a survey of 72 primary care groups and trusts. That survey is now in its second year. The first report highlighted some of the issues that arise from partnership working, and provided some valuable information. The results of that research will be in the public domain, so that we can establish the benefits of closer partnership working. 
 The Committee has a simple choice on new clause 16: it must decide whether that material should be included in the Bill. I say that it is not necessary. We have strong arrangements in place to review the performance of care trusts and to allow that information to be in the public domain. If the hon. Gentleman presses the new clause to a Division, I ask my hon. Friends not to vote for it. However, I hope that the hon. Gentleman will feel sufficiently mollified and reassured not to press it.

Philip Hammond: I cannot say that I feel especially mollified by the Minister's words. He has his emollient days and his less emollient days, but I do not feel particularly mollified. He started by saying that the Government will review the arrangement objectively and rigorously, but went on to assert that they are strongly of the view that care trusts are a positive development. That is exactly my worry: the Government are, in effect, writing the verdict before evaluating the case.
 In answer to my intervention on NHS Direct, the Minister cited an example—a good one—of a benefit that NHS Direct has achieved, but he will know, because he is a rigorous thinker, that one example, or even 100 examples, does not prove or disprove a case. He will know also that it was fairly scurrilous of him to ask me if I would tell the Committee what price or value I would put on a life. That was a horrendous question. However, because of the nature of the Department's work, cost benefit analyses have to address such difficult questions, because directing resources into one area necessarily takes them from another. It is a question not of how much value we put on a life, but of how many lives can be saved or enhanced with the available resources. The Minister knows that very well. 
 I shall look forward to the National Audit Office report on NHS Direct. We shall then discover whether the NAO, an independent and well-respected body, believes that the review process—the assessment of NHS Direct that took place before the announcement of the nationwide roll-out—was indeed a properly rigorous process that addressed objectively the costs and benefits of the service. 
 I am far from reassured by what the Minister said. I accept entirely that he will want to review the workings of care trusts. I wonder, however, whether the Government will be objective enough to allow that information into the public domain if it does not support their strongly held view, as clearly outlined by the Minister, that care trusts are a positive development. If that review process does not support that view, I would be surprised if Ministers rushed to get the results into the public domain. 
 Having listened to the Minister, and given that we shall have an opportunity to reconsider these matters next week on Report—perhaps, in the case of review mechanisms, on a slightly broader basis than just care trusts—I beg to ask leave to withdraw the motion. 
 Motion and clause, by leave, withdrawn.

New Clause 17 - Observer status at meetingsof health authorities

``Health authorities shall extend observer status, with voice but no vote, to representatives of all statutory patient representation bodies.''--[Mr. Burstow.]
 Brought up, and read the First time.

Paul Burstow: I beg to move, That the clause be read a Second time.
 The new clause is brief and clear. I hope that the Minister can accept it.

Desmond Swayne: Will the Minister confirm my understanding that health authorities conduct much of their business in public—in which case, observer status exists. For business that is taken in private, my understanding is that the Bill will ensure that statutory patient bodies will have a representative on the board of the health authorities.

John Denham: I congratulate the hon. Member for New Forest, West on paying such close attention to our proceedings. It is indeed our intention that patient bodies should be able to elect a member to be on the board of the trust, rather than the health authority. That may be the distinction made by the hon. Member for Sutton and Cheam.
 We do not accept the new clause because our approach is different. We want to create an advisory forum to work with the health authority. It will certainly include representatives from patients' boards and a wide range of other local representatives. We want it to be a guiding organisation and a sounding board when health authorities develop the strategic direction of the local health authority. Much of the business of health authorities is, of course, conducted in public, though not all of it. We think that the place for patient representation is within the local advisory forum rather than through observer status on the health authority.

Paul Burstow: I am disappointed by that response. Health authorities play an important role as commissioners and scrutineers of the NHS economy in their area. The Minister says that the relationship between patients forums and the other statutory bodies to be established by the Bill will be at arm's length, and through a non-statutory body. That seems unsatisfactory for the accountability framework that the Government are establishing. We will want to return to that issue on Report.
 I recently tabled a question to ascertain some information about the costs of the new arrangements, and was told that it was too early in the parliamentary process for me to receive information about how much the new system will cost. I shall keep that in mind in future when Ministers ask us when we move amendments for detailed costings and the detail of the proposals behind them. Clearly, Ministers accept that they can introduce legislation without detailed costings or, indeed, details to back up the proposals. However, I beg to ask leave to withdraw the motion. 
 Motion and clause, by leave, withdrawn.

New Clause 18 - Liability for residential care charges

`.—(1) Where a person—
(i) has previously made their own arrangements for care and attention in a residential care or nursing home, and
(ii) has requested an assessment under section 47 of the National Health Service and Community Care Act 1990 inter alia to obtaining community care services, including accommodation provided under section 21(1), and
(iii) the authority has assessed that person as being in need of such care and attention under section 21(1)
any liability of that person to make any payments under existing arrangements, or alternative arrangements which may be made, shall cease either at the date that the request for the assessment is notified to the local authority or at the date at which the person becomes financially eligible for assistance (under regulations made for the purposes of section 22 of this Act) if later, and liability shall pass to the local authority to fund that care and attention at that date. Regulations may provide for criteria as to whether the existing arrangements continue.
 (2) However the responsible authority may in respect of any payment made by them in pursuance of subsection (3) recover from that person such an amount in accordance with regulations made for the purposes of section 22 of this Act.
 (3) A person will be entitled to recover any monies paid in excess of that for which he is liable in accordance with the regulations made for the purposes of section 22 of this Act, from the point the local authority became liable under section 21(3).'.--[Mr. Burstow.]
 Brought up, and read the First time.

Paul Burstow: I beg to move, That the clause be read a Second time.
 The new clause aims to address an anomaly and unfairness that sometimes occurs if people who are already in residential nursing homes are currently above the limit for the application of a means test and are self-funding. If they foresee that they will fall below the limit, they apply to the local social services department for an assessment of their needs with a view to becoming state-supported when they fall below the capital limit. 
 Age Concern has referred evidence to me—and hon. Members have referred to the practice in representations to the Committee—that some local authorities operate waiting lists and delay the time between the initial application for an assessment and when they carry it out. As a result, some people—but not all—are already below the capital limit when the assessment kicks in and state funding becomes available. They have thus lost the money that the state should not have taken from them in payments that they have had to make for their fees. 
 New clause 18 would ensure that people received their full entitlement under the Government's means-testing arrangements, and did not lose money so that they fell below the capital limits. Under the new clause, if they were driven below the limit, they would be entitled to a refund.

Philip Hammond: Perhaps the hon. Gentleman can save the Committee time by responding to an intervention. I am baffled by new clause 18. I have read it and can make no sense of it. Subsections (1) and (2) refer to clause 22, which deals with unsuitability for inclusion in medical lists. Can the hon. Gentleman explain what it is about?

Paul Burstow: I can explain that there is a drafting error. The hon. Gentleman is good at spotting drafting errors in Government Bills and amendments, so it is right for me to point this out. We intended the issue to be dealt with on Tuesday, when we were discussing clauses relating to residential care. Unfortunately, at that point it did not fit into the order of business and, as a result we tabled it as a new clause. I suspect that something occurred in the drafting that led to the error.
 I hope that I have made clear the policy intention behind the new clause, even if the text on the order paper is not as clear as it should be.

Michael Jabez Foster: I support the need to take action, not in the way proposed in the new clause, but through direction or some other medium to enable folk who are in that position to be compensated. In East Sussex, as many as one in four applicants are eligible. They are already placed in nursing homes, and that creates enormous challenges for local authorities and individuals. Local authorities are treating the £16,000 limit merely as guidance: they seldom treat it as an obligation to take early action. That is a problem in East Sussex because of resources, but it is also happening elsewhere. People face the double whammy of a delayed assessment and a further delay before an allocation of funds is made.

Simon Burns: Is the hon. Gentleman aware that it is not only a double whammy, but that up until a court case a few years ago, it was a treble whammy? There was the obscenity of Labour-controlled Sefton council refusing to accept the will of Parliament. It would not implement the £16,000 limit until the Government took it to court to enforce the law.

Michael Jabez Foster: I am not aware of that case. East Sussex has a Liberal Democrat council that is in difficulty. I am not suggesting that this is a matter of ill will for many local authorities. Problems arise and need to be resolved. If the limit is £16,000, that is it.
 I suspect that in theory the law already enables an individual to seek recompense. In practice, however, I do not believe that that often happens, because of the difficulties involved in litigation, and local authorities often respond quickly if efforts are made by the Member of Parliament or others to bring the matter to their attention. 
 I do not believe that the new clause would solve the problem, because it is offers an open cheque book. It suggests that there should be a total indemnity or that the contract should be assigned. That is a messy way of dealing with assignment of contract. In any event, the charging rates that the individual may have agreed could not be imposed on the local authority. However, it would be helpful if the Minister could tell us whether local authorities could be directed to accept the obligation by way of an indemnity from the moment the person becomes eligible to the moment that the assessment is agreed and allowed, so that the person would at least have the assurance that his limited means were not being further reduced while awaiting the outcome of the process.

John Hutton: I am grateful to the hon. Member for Sutton and Cheam and my hon. Friend the Member for Hastings and Rye (Mr. Foster) for their comments. There is no question but that the issue is serious and needs to be addressed. The hon. Member for Sutton and Cheam has proposed a solution, but he will not be surprised to hear that I shall not endorse it, for two reasons. First, it is not well drafted and contains references to statutes that do not exist, which is a problem, as I am sure he will understand. Secondly, it is unnecessary, as I shall explain.
 As I understand the new clause, notwithstanding difficulties in understanding it because of how it has been drafted, it is designed to ensure that when a person who has previously funded his own care, but whose resources have been reduced to the level at which he might be eligible for council support, has been assessed as being eligible for council support, the council will take financial responsibility for his care, either from the date that the request for assessment was made to the council or the date that the person becomes eligible for assistance, if that is later. 
 Opposition Members and my hon. Friend the Member for Hastings and Rye expressed anxieties about older people in care homes who are in the difficult circumstances of having spent down to the capital limit while local authority financial support is either delayed or has not been delivered as and when it should have been. My hon. Friend the Member for Hastings and Rye asked what the Government planned to do about that. I remind him and the hon. Member for Sutton and Cheam that the Government have already taken action. 
 In 1998 we issued statutory guidance to local authorities clarifying and confirming the legal responsibilities of local authorities. When the capital of a person in residential care or a nursing home has been reduced to the upper capital limit, the local authority should, as soon as is reasonably practical, undertake an assessment, and when necessary step in to take over arrangements to ensure that the resident is not forced to use up capital below the appropriate limit. The hon. Member for Sutton and Cheam and my hon. Friend the Member for Hastings and Rye asked what would happen if a resident were forced to spend additional capital. I understand that if someone has been asked to contribute to the cost of his residential care outwith the means test, there is a clear liability and responsibility on the local authority to put that right. The hon. Member for West Chelmsford (Mr. Burns) is well aware of that, having had ministerial responsibility for these matters. There is no doubt about the legal effect of the upper and lower capital limits. 
 The framework for means-tested charging for residential care is set by Parliament. It is the law of the land. No one can opt in or out, and no one should be asked to contribute unfairly, outwith the terms of the means test. If a resident is asked to contribute in that way, it raises the issue of compensating him for the charges that he has been asked to pay.

Paul Burstow: On that point, the Minister referred to the guidance, which I believe is LAC 98/19. As I do not have that guidance before me this afternoon, will he tell me whether the guidance specifically states what the Minister has said today, which is that there is a clear liability on the local authority to make good that payment.

John Hutton: I shall have to let the hon. Gentleman know. I do not have the guidance in front of me. I wish that I did. It would speed up the process.
 The law is the law. I am not sure that it would add value if the Department were to tell local authorities, ``It is your obligation to obey the law, and if you don't you have to make financial compensation.'' I can see the hon. Gentleman's point—that that would put the issue beyond doubt and everything would be clear—but as I understand it, there is no doubt about the legal situation, and the issue has been properly addressed by the Department.

Simon Burns: Was that guidance issued by the Department as a direct result of the court decision on Sefton?

John Hutton: With the greatest respect, I cannot say. I will correspond with the hon. Gentleman on that. The guidance predates my time as a Minister in the Department by several months and I am not aware of the events leading up to the issuing of that guidance. It was issued by my right hon. Friend the Member for Brent, South (Mr. Boateng), now the Minister of State, Home Office, and so I simply do not know the answer—although apparently it was issued before the Sefton case.

Simon Burns: But the Sefton case was in 1997.

John Hutton: That is what I am informed.

Philip Hammond: I think this is a related subject—I am sure that you, Mr. Maxton, will tell me if it is not. Will the Minister clear up something else? He will be aware of the practice of some local authorities of applying heavy pressure on care home owners not to admit residents as self-payers unless they can demonstrate a certain amount of capital above the upper threshold. That puts potential self-paying residents in a difficult position. Is there any legal basis for councils to involve themselves in the decision by private care home owners to admit self-funding residents? Will he make it clear that the Government deprecate any attempt by local authorities to limit people who are self-funding from being admitted into care homes simply because it is possible that ultimately their capital will be exhausted and they will become a charge on the local authority?

John Hutton: As the hon. Gentleman will recognise, that is likely to be the case for many self-funders—not all of them, it obviously depends how long they stay in residential care. These are complicated matters, as I am sure that the hon. Gentleman would accept. We want local authorities to treat self-funders fairly and properly—in the same way that they would treat people who are not self-funding. They have a responsibility to do that and we want people to receive the right information at the right time so that they can make the appropriate arrangements in their best interests.
 I am now informed that the guidance was issued after the Sefton case, so I hope that that clears up the issue. Whether that was directly as a result of the Sefton case, I do not know, but I will deal with that in correspondence.

Peter Brand: In his correspondence, will the Minister also explain how people can seek redress if the law should be broken—either wittingly or unwittingly; either through delay or through false or mistaken advice being given? The mechanism open to individuals to seek redress is extraordinarily complex, and we all will have had cases brought to us in which it is almost possible to call the local authority to account without going through the courts, which of course is not open to many people.

John Hutton: It is obviously in everyone's best interest for those issues to be properly dealt with by the local authorities in the first place. If that has not happened, redress must be sought in the appropriate way: if the matter has been brought to the attention of the local authority, it should sort it out and avoid prolonged arguments about who should pay for what. Other jurisdictions may be able to benefit the resident who feels unfairly treated: the local government ombudsman and ultimately the courts are there to enforce and uphold the law. I very much hope it would not have to come to that. My understanding is clear: local authorities have a specific duty to take responsibility for people when they meet the criteria for financial assistance within the means test. If they do not do that in a timely fashion and someone loses out financially as a result, the issue can be addressed sensibly and amicably by the local authority accepting its responsibility. If that does not happen, I am afraid that the resident will have to use other means at his or her disposal.

Simon Burns: As the Minister has kindly promised to write to Committee members about Sefton, in the light of his last comments, will he tell us in the same correspondence whether the people who lost out living in the Sefton local authority area were compensated after the court case and guidance?

John Hutton: I shall certainly try to advise the hon. Gentleman about that matter. If my memory is right, the Sefton case was dealt with in an earlier circular by my Department, but I will check so that we get the correct information. The circular that we are discussing in the context of the hon. Gentleman's amendment deals with a different, separate point about at what moment the local authority should assume responsibility. In the Sefton case, the legal status of the upper and lower capital limits was the issue in question.

Philip Hammond: I may have missed this, but in the Minister's response to my earlier intervention, I did not get a clear understanding of whether his answer was that a local authority does or does not have a legal right to seek to intervene in a self-funding placement simply on the basis that it may eventually incur the liability due to the exhaustion of capital. Will the Minister be clear about the matter? Does a local authority have any legal right to make such an intervention?

John Hutton: I am not sure that it does. I must take specific legal advice on the matter and I will inform the hon. Gentleman and the Committee when I have it.
 This has turned out to be one of those debates that has gone wider, deeper and broader than I anticipated when I flicked through my notes as to how to respond. It has been useful and we have discussed some interesting issues of both principle and practice that relate to how people in care homes should be treated. If members of the Committee, speaking as constituency Members of Parliament, came across such a case involving an older person, they would be determined to ensure that that person was properly compensated. I certainly would, because I believe that that is an entitlement. 
 For reasons that I have tried to explain, the amendments tabled by the hon. Member for Sutton and Cheam do not clarify the position. The law is clear about responsibilities and when they are triggered on the part of the local authority. We have dealt with the issues that he raised in statutory guidance under section 7 of the Local Authority Social Services Act 1970, which, as he knows, local authorities are required to follow unless they have compelling reasons not to do so. The position in law is clear and it is backed up with clarification and guidance. Therefore, his amendment, well intentioned and honourable though it is, is not necessary.

Paul Burstow: As the Minister said, this has been a useful debate on the issue. I am grateful to the hon. Member for Hastings and Rye for his contribution in raising concerns from his experience in his constituency. The Minister has gone some way towards giving the assurances that Age Concern and I were seeking. The law is clear, but it is apparent that the practice in a number of local authorities is not. The Minister has made some helpful comments about the current statutory guidance. I hope that he and his officials will reflect on the debate and re-examine the existing guidance to satisfy themselves that the clear statement that the Minister has given the Committee today is the clear statement that local authorities are left with too, so that when dealing with such matters the local authorities are doing what the Minister, quite rightly, said should happen. I beg to ask leave to withdraw the motion.
 Motion and clause, by leave, withdrawn.

New Schedule 1 - `PARTNERSHIP ARRANGEMENTS: TRANSFER OF STAFF - The following is the Schedule inserted in the Health Act 1999. - ``SCHEDULE 2A - SECTION 31 ARRANGEMENTS: TRANSFER OF STAFF

Application of Schedule 
 1. This Schedule applies where, under any arrangements under regulations under section 31, any functions of a body (``the transferor'') are to be exercised by another body (``the transferee'').
Orders transferring staff
 2.—(1) The Secretary of State may by order transfer to the transferee any specified description of employees of the transferor.
 (2) An order may be made under this paragraph only if any prescribed requirements about consultation have been complied with in relation to each of the employees to be transferred.
 (3) In sub-paragraph (2) ``prescribed requirements'' means requirements prescribed for the purposes of that sub-paragraph by regulations made by the Secretary of State.
Effect of order on contracts of employment
 3.—(1) The contract of employment of an employee transferred by an order under paragraph 2—
(a) is not terminated by the transfer, and
(b) has effect from the date of the transfer as if originally made between the employee and the transferee.
 (2) Without prejudice to sub-paragraph (1)—
(a) all the rights, powers, duties and liabilities of the transferor under or in connection with the employee's contract of employment shall by virtue of this sub-paragraph be transferred to the transferee, and
(b) anything done before the date of the transfer by or in relation to the transferor in respect of the employee or his contract of employment shall be deemed from that date to have been done by or in relation to the transferee.
 (3) Sub-paragraphs (1) and (2) do not transfer an employee's contract of employment, or the rights, powers, duties and liabilities under or in connection with it, if he informs the transferor or the transferee that he objects to the transfer.
 (4) Where an employee objects as mentioned in sub-paragraph (3), his contract of employment with the transferor shall be terminated immediately before the date on which the transfer would occur; but he shall not be treated, for any purpose, as having been dismissed by that body.
 (5) This paragraph is without prejudice to any right of an employee transferred by an order under paragraph 2 to terminate his contract of employment if a substantial change is made to his detriment in his working conditions; but no such right shall arise by reason only that, under this paragraph, the identity of his employer changes unless the employee shows that, in all the circumstances, the change is a significant change and is to his detriment.
Effect of order on pension rights
 4.—(1) An order under paragraph 2 may provide that, in the case of an employee of any specified description who is transferred by the order, paragraph 3 shall not apply in relation to—
(a) so much of the employee's contract of employment as relates to relevant pension provisions, or
(b) any rights, powers, duties or liabilities under or in connection with that contract, or otherwise arising in connection with the employee's employment, and relating to such provisions.
 (2) If an order under paragraph 2 provides as mentioned in sub-paragraph (1), the order may in relation to any such employee make such provision (if any) as the Secretary of State considers appropriate with respect to all or any of the matters mentioned in paragraphs (a) and (b) of that sub-paragraph.
 (3) The provision which may be made by virtue of sub-paragraph (2) includes provision—
(a) for any such employee's contract of employment with the transferee to have effect with any specified modifications;
(b) for relevant pension provisions of any specified description to have effect in the case of any such employee with any such modifications.
 (4) In this paragraph ``relevant pension provisions'' means the provisions of an occupational pension scheme within the meaning of the Pension Schemes Act 1993, with the exception (if the order under paragraph 2 so provides) of any provisions of such a scheme falling within a description specified in the order.
Divided employments
 5.—(1) Where an employee is to be transferred by an order under paragraph 2 but is to continue to be employed for certain purposes by the transferor, the order may provide that the contract of employment of the employee shall, on the date on which the employee is transferred, be divided so as to constitute two separate contracts of employment between the employee and the transferor and between the employee and the transferee.
 (2) Where an employee's contract of employment is divided as provided under sub-paragraph (1)—
(a) the order shall provide for paragraph 3 to have effect in the case of the employee and his contract of employment subject to appropriate modifications; and
(b) paragraph 4 shall similarly apply only so far as appropriate in connection with the employee's employment by the transferee.''.'.—[Mr. Denham.]
 Brought up, read the First and Second time, and added to the Bill. 
 Question proposed, That the Chairman do report the Bill, as amended, to the House.

John Denham: This has been an extremely good Committee stage. Despite some fears that were expressed about the consequences of programming motions, we have been able to give due time to the key provisions that are necessary to implement the NHS plan that the Government published last year.
 I place on record my thanks in the normal way to the Officials of the House who have serviced the Committee efficiently, and to the Hansard writers. I also thank the officials who have supported my fellow Minister and me throughout the passage of the Bill. Officials do a huge amount of work to support Ministers during the consideration of a Bill. No one would say that it was an easy job at the best of times, but we should acknowledge a side-effect of the programming motion. The avoidance of sittings into the early hours of the morning means that officials do not need to remain here as late.

Philip Hammond: It is all part of the fun.

John Denham: The hon. Gentleman may say that it is all part of the fun, but it is not much fun for officials, who have to be back in the office at half-past 6 or 7 o'clock the next morning, to prepare briefing on amendments. Those things are important and are not forgotten.
 The vast majority of members of the Committee have contributed to the debate, and I acknowledge the role played by the Opposition. The hon. Member for Woodspring (Dr. Fox) has hardly been here and has not taken a great deal of interest in our proceedings, but the Committee will be memorable for the entry on to the Opposition Front Bench by the hon. Member for New Forest, West. His book of quotations will soon rival that of Dan Quayle in the bookshops. 
 The attention shown by the hon. Member for Runnymede and Weybridge (Mr. Hammond) has been noteworthy; he has excelled himself. The hon. Members for Sutton and Cheam and for Isle of Wight, who shared the duties on the Front Bench for the Liberal Democrats, also participated fully in the debates and raised many important issues. 
 The usual channels have done their job discretely and well, despite the official state of hostilities over the issue of the programming motion, and successfully guided us to the point that we have reached today. I acknowledge, too, the contribution of outside bodies, which made representations and drafted so many of the Opposition amendments and several of our own. 
 Finally, Mr. Maxton, I thank you and Sir David Madel for the way in which you chaired our sittings. Your interpretation of the rules around amendments and stand part debates means that we have always had well-organised debates. We have been able to concentrate on the right issues at the right time, without having to be too constrained by the formalities, but we have also avoided a great deal of duplication.

Philip Hammond: I am grateful to have the opportunity, on behalf of the Opposition, to thank you for your enlightened chairing of the Committee, Mr. Maxton—and for that of your co-Chairman, Sir David Madel.
 I am not sure that I have been in the same Committee as the one described by the Minister, however. This is the first Committee that I have served on since the programming regime came into force, and I do not think that we have had enough time to debate fully all the clauses. Clauses 17 and 18, for example, did not get an airing at all. From a Minister's point of view, it is preferable to have predictable business in the Committee, and no doubt officials also welcome it. However, perhaps the Government should consider reducing the legislative programme if they want to lighten the load on officials. 
 On a personal note, I am disappointed not to have found a single punctuation or spelling error in the Bill. It is usually my objective to find an amendment that is so trivial that even the Minister cannot object to it, but I have failed on this occasion. 
 I would like to thank the Clerk, who provides an enormously valuable resource to those who are less well resourced than the Minister—that is, to all the Opposition Members in the Committee and, I suspect, to your co-Chairman and yourself, Mr. Maxton. Without the Clerk, we would not have been able to conduct the proceedings with anything like the dispatch and efficiency that we have experienced. 
 I pay tribute, too, on behalf of all Opposition Members, to the work done by our meagre staff, although they were no match for the Minister's team of thousands who beavered away through the night to prepare him.

John Denham: It would come as a terrible shock.

Philip Hammond: The Minister says it will come as a terrible shock, and I look forward to that, sometime in early May. Our staff work incredibly hard to produce the amendments, which Conservative Members—I cannot speak for the Liberal Democrats—generally produce by ourselves. We are, however, grateful for the input from outside bodies.
 I should also like to thank the staff of the House who have served the Committee, including the Hansard writers and the police officers who have attended throughout, who, collectively, must have absorbed a phenomenal body of wisdom over the years.

David Jamieson: From listening to the hon. Gentleman.

Philip Hammond: I do not mean, as the Government Whip has just said, that they have absorbed wisdom by listening to me! I was thinking of the collective wisdom of all Members of Parliament over many years. That must give the police officers—when eventually they retire and sit at home reflecting on their careers—some really meaty issues to think about.
 It has been a great pleasure to serve under your chairmanship, Mr. Maxton, and I thank you on behalf of all Opposition Members.

Peter Brand: May I join in the traditional pleasantries? I am not certain about our worthy policemen absorbing wisdom. I think that they develop a great deal of tolerance.
 The timetabling has been helpful, because it has allowed us to concentrate on the important elements of the Bill. One of our concerns, however, is that there has been so little time between Second Reading and the onset of the Committee cycle. Of greater concern is the very short time between today and the consideration of the Bill on Report. It would be extremely helpful if the Minister and his officials had a little time to reflect on the substance of our debates in Committee. The officials might then be able to produce a draft that would be more relevant to some of the Minister's pronouncements. His words have been very encouraging, but will not necessarily be reflected in the debate on Wednesday. I hope that there will be time for that, because the most enthusiastic people—whenever the Minister has spoken—have been his officials. They, apparently, are full of enthusiasm for the fact that what they have drafted reflects what he is saying. Such faith is to be encouraged, but has also to be tested. I am sorry that we do not have sufficient time between now and Wednesday to test it. 
 I thank you, Mr Maxton, Sir David Madel, and, of course, the Clerk. I must also mention our research staff. We are not funded the same way as the official Opposition, and thus much beavering goes on. I am glad that we have, at least, aired many of the subjects, and hope that a better Bill finally emerges from the other place, because I am not too hopeful for next Wednesday.

John Maxton: This is the only opportunity that the Chairman gets to speak. I thank all three hon. Gentlemen for their kind remarks. I shall pass on their thanks to Sir David Madel for the time he spent in the Chair last week. I am sure that the Doormen, the Hansard writers, and the policemen will have heard the remarks that have been made, and will pass on our thanks to others who have been present during our proceedings.
 I add my thanks to the Clerk. Without a Clerk, no Chairman can operate, although, very occasionally, the Clerk cannot operate without the Chairman. It is, however, nearly always the other way around. 
 This, I think, has been a very good-tempered, good-humoured and tolerant Committee, despite the time constraints that some Members may have felt. I am grateful to all Members for making my job so easy. 
 I wish to make two final points. First, my long legs often make it almost impossible for the invisible people who work here to get past me, and—even though they do not officially exist—I apologise to them. Secondly, may I say something with regard to policemen and their collective wisdom, to which the hon. Member for Runnymede and Weybridge referred? The policemen are probably like the Chairman. They switch off and think of other things. I am sure that, like the Chairman, they would not wish to tell the Committee what is in their minds. 
 Bill, as amended, to be reported. 
 Committee rose at twenty-five minutes past Four o'clock.